RT Journal Article
SR Electronic
T1 Comparison of Diffusion-Weighted MRI Using Single-Shot Echo-Planar Imaging and Split Acquisition of Fast Spin-Echo Signal Imaging, a Non-EPI Technique, in Tumors of the Head and Neck
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A8529
A1 van der Hulst, Hedda J.
A1 Braun, Loes
A1 Westerink, Bram
A1 Agrotis, Georgios
A1 ter Beek, Leon C.
A1 Tissier, Renaud
A1 Ahmadian, Milad
A1 Martens, Roland M.
A1 Casselman, Jan W.
A1 Beets-Tan, Regina G.H.
A1 van den Brekel, Michiel W.M.
A1 Castelijns, Jonas A.
YR 2025
UL http://www.ajnr.org/content/early/2025/03/27/ajnr.A8529.abstract
AB BACKGROUND AND PURPOSE: DWI using single-shot echo-planar imaging (DWI-EPI) is susceptible to distortions around air-filled cavities and dental fillings, typical for the head and neck area. Non-EPI, split acquisition of fast spin-echo signals for diffusion imaging (DW-SPLICE) could reduce these distortions and enhance image quality, thereby potentially improving recurrence assessment in squamous cell carcinoma (SCC) of the head and neck region. This study evaluated whether DW-SPLICE is a viable alternative to DWI-EPI through quantitative and qualitative analyses.MATERIALS AND METHODS: The DW-SPLICE sequence was incorporated into the standard 3T head and neck MRI protocol with DWI-EPI. Retrospective analysis was conducted on 2 subgroups: first benign or malignant lesions, and second, posttreatment SCC recurrence. In both subgroups, image quality and distortion were scored by 2 independent radiologists, blinded to the DWI technique and evaluated using mixed-effect linear models. Lesion ADC values were assessed with interclass correlation and Bland-Altman analyses. The delineation geometric similarity of DWI to T1-weighted postcontrast MRI was evaluated using the DSC before and after registration. Recurrence in posttreatment SCC scans was evaluated by the same 2 radiologists blinded to the DWI technique. Recurrence detection rates were then compared between DW-SPLICE and DWI-EPI using mixed logistic regression at 6 months and 1 year postscan follow-up data.RESULTS: From August 2020 to January 2022, fifty-five benign or malignant lesion scans (55 patients) and 74 posttreatment SCC scans (66 patients) were analyzed. DW-SPLICE scored better on image quality and showed less overall distortion than DWI-EPI (0.04<P < .001). There was high ADC measurement reliability (intraclsss correlation coefficient = 0.93, P < .001), though a proportional bias was also observed (β = 0.11, P = .03), indicating that the bias increases as ADC values increase. DW-SPLICE exhibited greater geometric similarity to T1WI with gadolinium contrast before registration (DSC 0.63 versus 0.47, P < .001) and outperformed DWI-EPI by more accurately identifying recurrences after 1 year (OR  = 0.96, P = .05) but not after 6 months (OR  = 0.72, P = .13).CONCLUSIONS: DW-SPLICE surpasses DWI-EPI on image distortion and quality and improves diagnostic reliability for detecting recurrent or residual SCC on 3T MRI of the head and neck. Consistent use of 1 method for follow-up is advised, because ADC values are not completely interchangeable. Integrating DW-SPLICE can significantly improve tumor assessments in clinical practice.DSCDice similarity coefficientDW-MS-EPIdiffusion-weighted multishot echo-planar imagingDW-SPLICEdiffusion-weighted split acquisition of fast spin-echo signal for diffusion imagingDW-TSEdiffusion-weighted TSEHNhead and neckICCintraclass correlation coefficientSCCsquamous cell carcinomaSENSEsensitivity encodingT1WIcT1-weighted imaging with gadolinium contrast